The Impact of Dexamethasone Administration on Labor Progression in Pregnant Women: A Randomized, Double-Blind Clinical Trial.

Abstract

Background: The role of dexamethasone in labor progression during the latent and active phases has been widely debated. This study aimed to evaluate the effects of dexamethasone on labor progression, delivery outcomes, and neonatal health.

Methods: This multicenter, randomized controlled trial included 4 groups of pregnant individuals: (1) the first group-intervention in the active phase receiving dexamethasone; (2) the second group-intervention in the latent phase receiving dexamethasone; (3) the third group-control in the active phase; and (4) the fourth group-control in the latent phase. Participants were randomly assigned to each group. The primary outcomes were time from the latent phase to the active phase, duration of active labor, cervical dilation rate, and time from intervention to delivery. Secondary outcomes included cesarean section rate, adverse events (vaginal bleeding, fetal heart rate [FHR)] decelerations), and neonatal outcomes (Appearance, Pulse, Grimace, Activity and Respiration [APGAR] scores and neonatal intensive care unit [NICU] admissions). Statistical analyses included 1-way analysis of variance for normally distributed variables, the Kruskal-Wallis test for non-normally distributed variables, chi-square and Fisher exact tests for categorical data, and Bonferroni correction for multiple comparisons.

Results: A total of 120 participants were enrolled, with 75 in each group. The first group had the shortest time from the latent to active phase (4.85 hours, 95% CI: 4.32-5.38) and the shortest duration of active labor (1.91 hours, 95% CI: 1.52-2.30), compared to the other groups (P < 0.001). Cervical dilation rate was also highest in the first group (2.57 cm/hour, 95% CI: 2.13-3.01), significantly faster than in other groups (P < 0.001). The first group demonstrated the shortest time from intervention to delivery compared with the second and third groups (7.21 hours, 95% CI: 6.31-8.11), significantly shorter than the second (9.32 hours, 95% CI: 8.23-10.41) and third groups (9.05 hours, 95% CI: 8.15-9.95) (P < 0.001). There were no significant differences in cesarean section rates despite the differences in labor times and progression (5% overall, P = 0.320), with the second group having the lowest rate (0%) and the first group the lowest among interventions (3.33%). Adverse events, including vaginal bleeding and FHR decelerations, were rare and did not show significant differences. Neonatal APGAR scores were high across all groups (1 minute: 9, 95% CI: 8.8-9.2; 5 minutes: 10, 95% CI: 9.9-10), with no significant differences between groups.

Conclusion: Dexamethasone administration during the active phase of labor significantly shortened the time from the latent phase to active labor, reduced the duration of active labor, and enhanced cervical dilation rate, without adversely affecting neonatal health or increasing adverse events. Further studies are needed to confirm these findings and assess the long-term effects on both maternal and neonatal outcomes.